tbuckley/cabot-search huggingface dataset:
Abstract 15248: Clinical Outcomes of Transcatheter Aortic Valve Replacement With and Without Percutaneous Coronary Intervention - An Updated Meta-Analysis and Systematic Review
Authors: Mohammad Yassen, Abdelmoniem Moustafa
Journal: Circulation (2022)

Hypothesis: Transcatheter aortic valve replacement (TAVR) serves as a less-invasive treatment option for high-risk patients with severe aortic stenosis. Given the coexistence of obstructive coronary artery disease in patients with high-grade aortic stenosis (estimated to be 40-75%), there is inconsistent clinical data regarding potential mortality benefits of paired percutaneous coronary intervention (PCI) with TAVR procedures. Methods: We performed a literature search using PubMed, Embase, and Cochrane Library from inception through April 2022 to assess the mortality impact of preceding/concomitant PCI in patients undergoing transcatheter aortic valve replacement. The primary outcomes were 30-day all-cause mortality, 30-day cardiovascular mortality, and 6 months-1 year all-cause mortality. Secondary outcomes included 30-day myocardial infarction, stroke, major bleeding/vascular complications, and acute kidney injury. Results: 11 studies (10 retrospective cohort studies, 1 randomized control trial) involving 2791 patients were included in the meta-analysis. Compared to patients undergoing TAVR alone, the TAVR+PCI group showed no significant difference in 30-day all-cause mortality (RR 0.90, CI 0.66, 1.22, p =0.49), 30-day cardiovascular mortality (RR 0.71 CI 0.44, 1.14, p =0.16), or 6 months-1 year all-cause mortality (RR 0.94, CI 0.75, 1.18, p =0.57). Regarding secondary outcomes, 30-day myocardial infarction was higher in the TAVR+PCI group compared to the TAVR group (RR 3.09, CI 1.26, 7.57, p =0.01), while no significant differences were found in rates of 30-day stroke (RR 1.14, CI 0.56, 2.33, p =0.72), major bleeding/vascular complications (RR 1.11, CI 0.79, 1.56, p =0.55), and acute kidney injury (RR 1.07, CI 0.75, 1.54, p =0.71). Conclusion: Concomitant/preceding percutaneous coronary intervention does not confer any additional mortality benefit, and may increase the risk of 30-day myocardial infarction, in patients with high-grade aortic stenosis undergoing transcatheter aortic valve replacement. Further trials with large sample sizes are needed to confirm our findings.
Abstract 15677: Comprehensive Physiological Phenotyping Reveals Deconditioning Among Individuals With Long-COVID-19
Authors: Erin J Howden, Imogen Wallace, Jonathon Sesa-Ashton, Leah Wright, Tye Dawood, Vaughan Macefield, Andre La Gerche
Journal: Circulation (2022)

Introduction: Post-acute COVID-19 sequalae (PASC) is a poorly understood constellation of symptoms that persist or emerge following the post-viral convalescent period. We sought to comprehensively evaluate cardiac and autonomic function and deconditioning as possible contributors to PASC associated fatigue. Methods: Thirty individuals with PASC (20F:10M; 41±11yrs; 137-730 days post-infection) prospectively underwent measures of autonomic function (heart rate [HR] and muscle sympathetic nerve activity [MSNA] response to passive head-up tilt 60° [HUT]); cardiac function (echocardiogram); arrhythmia burden (24-hour Holter monitor); exercise capacity (cardiopulmonary exercise test); hemoglobin and inflammatory biomarkers (CRP, troponin, IL-6, TNFα, IL-10). Participants were stratified by ongoing fatigue and symptoms of breathlessness (SOB+ or SOB-). Individuals with pre-existing conditions associated with fatigue were excluded. Results: Sixteen individuals (53%) reported breathlessness. Other common symptoms were palpitations (n=9; 30%) and light-headedness (n=5; 17%). Exercise capacity normalised for age and gender was lower in breathless subjects (SOB+) than in non-breathless subjects (SOB-); 70±11% vs 85±15%, p =0.004. The SOB+ group tended to have a blunted MSNA response to HUT when compared to SOB- ( p =0.06), with similar prevalence of postural orthostatic tachycardia (SOB+ n=5 vs SOB- n=5). Echocardiography revealed that global longitudinal strain trended higher in the SOB+ group compared with SOB- ( p= 0.075), with similar prevalence of participants who fulfilled diastolic dysfunction criteria (SOB+ 5 vs SOB- 4). There were no significant sustained arrhythmias on 24-hour Holter monitoring. Hemoglobin, troponin and cytokines were all similar (p&gt;0.05), but CRP was higher in the breathless group ( p =0.016). Conclusions: This is the first comprehensive phenotyping of PASC with ongoing fatigue and breathlessness. We found that these symptoms were associated with reduced exercise capacity but without any associated cardiac impairment, arrhythmias, or autonomic dysfunction. These findings suggest that deconditioning may contribute to the pathophysiology of PASC.
Abstract 15669: Frataxin Deficiency-Dependent Gene Expression in Friedreich Ataxia Ipsc-Neurons and Cardiomyocytes
Authors: Mariana Burgos Angulo, Alexander V Bertalovitz, Mariana A Argenziano, jiajia yang, Theresa O Zesiewicz, Aarti Patel, Thomas V McDonald
Journal: Circulation (2022)

Introduction: Friedreich's ataxia (FA) is an autosomal recessive disease where expanded GAA trinucleotide repeat expansion in the first intron of the FXN gene results in transcriptional repression of the encoded protein, frataxin. FA is a progressive neurodegenerative disorder, but a primary cause of morbidity and mortality is hypertrophic cardiomyopathy, occurring in 60% of the patients. Several functions of frataxin have been proposed, but none of them can fully explain why its deficiency causes the FA phenotypes nor why the most affected cell types are neurons and cardiomyocytes. Hypothesis: We hypothesize that frataxin deficiency plays unique roles in FA-affected neural and cardiac cells. Methods: We generated induced pluripotent stem cell (iPSC)-derived neurons (iNs) and cardiomyocytes (iCMs) from an FA patient and normalized FXN expression via lentivirus without altering genomic GAA repeats at the FXN locus. Then we performed transcriptional profile and differential expression analysis to identify the dysregulated genes and enriched pathways. Results: Differential expression analysis identified 127 differentially expressed genes between transduced and non-transduced iNs (37 upregulated and 90 downregulated). The most significant enriched processes and pathways for iNs were Glycolysis (GO:0006096, KEGG:00010), ATP generation (GO:0006757), and ADP and Pyruvate metabolic processes (GO:0046031, GO:0006090). 417 genes were differentially expressed between transduced and non-transduced iCMs (320 upregulated and 97 downregulated). Enrichment analyses for iCMs demonstrated that frataxin deficiency affected the extracellular matrix organization (GO:0030198), collagen fibril organization (GO:0030199), and extracellular matrix receptor interaction (KEGG:04512). Genes in these pathways were differentially expressed when compared to a control and restored to control levels when FA cells were supplemented with frataxin. Conclusions: These results offer novel insight into specific roles of frataxin deficiency pathogenesis in neurons and cardiomyocytes. Glucose metabolism appears preferentially perturbed in neurons while pathways leading to fibrosis may play an important role in cardiac tissue.
Abstract 15631: Predictors of Functional Mitral Regurgitation Progression vs Regression in Patients With Non-Ischemic Cardiomyopathy: A Multi-Modality Study
Authors: Mustafa Turkmani, Tom Kai Ming K Wang, Gui Ting Liu, Donna Salam, Samir R Kapadia, Amar Krishnaswamy, Brian P Griffin, Scott D Flamm, Wai Hong W Tang, Deborah H Kwon
Journal: Circulation (2022)

Background: Functional mitral regurgitation (FMR) is associated with poor prognosis, however the determinants of FMR progression are not well understood. We aimed to determine clinical and cardiac magnetic resonance imaging (CMR) factors associated with FMR progression in patients with non-ischemic cardiomyopathy (NICM) who underwent baseline and follow-up echocardiography. Methods: NICM patients undergoing CMR between 12/2002-12/2017 with baseline (within 90 days of CMR) and follow-up echocardiography were evaluated. Progressive FMR was assessed by echocardiography based on reported FMR severity (none, mild, moderate, moderate-severe, severe). Associations between clinical and CMR parameters (left ventricular and left atrial (LA) size and function, late gadolinium enhancement, and mitral valve (MV) geometry quantification) and progressive FMR were assessed by univariable and stepwise multivariable linear regression. Results: Amongst 311 NICM patients (age 53±15.7 years, female 121 (38.9%)). A total of 17 patients (5.5%) had at least 1-grade of deterioration in FMR, while 66 patients (21.2%) had at least 1-grade of improvement. Univariable and multivariable analyses results are listed in the table. Mean baseline mitral regurgitant fraction by CMR was 14% ± 13%, while the mean of mitral regurgitation severity by echo was in the mild range (1.28 ±1). Baseline FMR grade by TTE (P&lt;0.001), CMR-LA volume indexed (P=0.003), sphericity ratio (P=0.005), MV annular mean indexed (P=0.027), and BMI (P=0.044) were independently associated with significant change in FMR. Conclusion: CMR-derived remodeling, LA and MV geometry parameters predicted progressive vs regression in FMR. Further studies are needed to determine if CMR predictors of FMR progression vs regression can improve selection criteria for procedural intervention vs guideline-directed medical therapy.
Abstract 15828: Baseline Hs-ctnt Concentrations Within the Sex-Specific Reference Range and Index Mortality in Emergency Department Patients
Authors: Yader Sandoval, Brad Lewis, Rajiv Gulati, Allan S Jaffe
Journal: Circulation (2022)

Background: High-sensitivity (hs) cardiac troponin (cTn) assays quantifies cTn in most healthy men and women. Whether quantifiable cTn concentrations below the 99 th percentile upper-reference limit have short term prognostic implications in emergency department (ED) patients remains uncertain. Methods: Multicenter (n=22) United States (US) cohort of ED patients undergoing at least one hs-cTnT measurement (CV Data Mart Biomarker cohort). For this assay, the lowest reportable concentration is &lt;6 ng/L. Sex-specific 99 th percentiles of 10 ng/L for women and 15 ng/L for men were used. The primary outcome was index hospitalization mortality. Results: A total of 85610 patients were examined, including 43043 women and 42567 men. A total of 775 index hospitalization deaths (0.91%) occurred, including 361 (0.84%) in women and 414 (0.97%) in men. Among women, baseline hs-cTnT concentrations were non-quantifiable (&lt;LoQ) in 37.5%, quantifiable (LoQ-99 th ) in 21.6%, and increased &gt;99 th percentile in 40.9%. Among men, baseline hs-cTnT concentrations were non-quantifiable (&lt;LoQ) in 20.0%, quantifiable (LoQ-99 th ) in 37.4%, and increased &gt;99 th percentile in 42.6%. Patients with higher concentrations were more likely to be older and had more comorbidities. Continuous baseline hs-cTnT (log) were associated with a higher odds of index hospitalization mortality (OR 1.26, 95% CI 1.24-1.28). Following multivariable analyses, quantifiable hs-cTnT (LoQ-99 th ) also were associated with index hospitalization mortality in all patients (OR 2.07, 95% 1.22-3.53), and in both women (OR 3.13, 95% CI 1.51-6.50) and men (OR 2.17, 95% 1.28-3.69) (Figure). Conclusions: Hs-cTnT concentrations within the reference range are more common in men than in women. Quantifiable hs-cTnT concentrations within the sex-specific reference range are associated with a higher risk of index hospitalization mortality, with a larger prognostic effect in women than in men.
Abstract 15705: Immunomodulatory Titanium Carbide MXene Nanosheets for Treatment of Cardiac Allograft Vasculopathy
Authors: Weiang Yan, ALIREZA RAFIEERAD, Keshav Narayan Alagarsamy, Rakesh C ARORA, Sanjiv Dhingra
Journal: Circulation (2022)

Introduction: Cardiac allograft vasculopathy is an aggressive form of atherosclerosis and a major cause of mortality among patients with heart transplants. Blood vessel endothelial cells stimulate alloreactive T-lymphocytes to result in sustained inflammation. MXenes are an emerging class of nanomaterials that have been shown to possess immunomodulatory properties. Herein, we report the first application of titanium carbide (Ti 3 C 2 T x ) MXene nanosheets for prevention of allograft vasculopathy. Methods and Results: Detailed physicochemical characterization of Ti 3 C 2 T x MXene nanosheets was performed using scanning/transmission electron microscopy, x-ray diffraction, and x-ray photoelectron spectroscopy. Ti 3 C 2 T x MXene nanosheets were 2 to 5 μm in size and enriched with biologically active surface groups. In vitro , MXene nanosheets interacted with human umbilical vein endothelial cells (HUVECs) and downregulated the expression of genes involved in alloantigen presentation through the class I major histocompatibility complex (IRF1, TAP1, B2M), and reduced the activation and pro-inflammatory polarization of co-cultured allogeneic lymphocytes. Consequently, RNA-Seq analysis of these lymphocytes showed that treatment with MXene nanosheets downregulated genes responsible for transplant-induced T-cell activation, cell-mediated rejection, and development of allograft vasculopathy. Furthermore, gene set enrichment analysis revealed significant negative enrichment of genes involved in interferon alpha/beta and interferon gamma signaling. Finally, in an in vivo rat model of allograft vasculopathy, treatment with Ti 3 C 2 T x MXene nanosheets reduced lymphocyte infiltration and preserved medial smooth muscle cell integrity within transplanted aortic allografts. Conclusion: These findings support the potential of Ti 3 C 2 T x MXene nanosheets for prevention and treatment of allograft vasculopathy and other inflammatory diseases. This research also opens the door to development of Ti 3 C 2 T x MXene technologies for other immune-sensitive regenerative medicine applications.
Abstract 188: Resuscitative Endovascular Occlusion Of The Aorta (REBOA) As A Mechanical Method For Increasing The Coronary Perfusion Pressure In Non-traumatic Out-of-hospital Cardiac Arrest Patients
Authors: Hee Eun Kim, Seung Min Park, Ki Chan Han
Journal: Circulation (2022)

Goal: Resuscitative endovascular balloon occlusion of the aorta (REBOA), originally designed to block blood flow to the distal part of the aorta by placing a balloon in trauma patients, has recently been shown to increase coronary perfusion in cardiac arrest patients. This study evaluated REBOA in increasing the aortic pressure and coronary perfusion pressure (CPP) in non-traumatic out-of-hospital cardiac arrest (OHCA) patients. Methods: Adult OHCA patients with cerebral performance category 1 or 2 prior to cardiac arrest, and without evidence of aortic disease, were enrolled from Jan. to Dec. 2021. Aortic pressure and right atrial pressure were measured before and after balloon occlusion. CPP was calculated using the measured aortic and right atrial pressures, and the values before and after the balloon occlusion were compared. Results: Fifteen non-traumatic OHCA patients were enrolled in the study. The median call to balloon time was 46.0 (IQR, 38.0-54.5) min. The median CPP before and after balloon occlusion was 13.5 (IQR, 5.8-25.0) and 25.2 (IQR, 12.0-44.6) mmHg, respectively (P=0.001). The median increase in the estimated CPP after balloon occlusion was 86.7%. Conclusion: The results of this study suggest that REBOA may increase the CPP during cardiopulmonary resuscitation (CPR) in patients with non-traumatic OHCA.
Abstract 15280: Lower Tricuspid Annular Plane Systolic Excursion/Pulmonary Artery Systolic Pressure Coupling is Associated With Longer Hospital Stay and Mortality in Patients With Pulmonary Hypertension
Authors: Daniel Oren, Cathrine Marie Moeller, Roy Raphael, Shaul Gelikas, Kobi Faierstein, Michal Canetti, Meir Mouallem, Haim Mayan, Noya Shilo
Journal: Circulation (2022)

Introduction: Heart failure (HF) is a leading cause of admissions to Internal Medicine (IM) wards worldwide and is associated with significant morbidity, mortality, and healthcare costs. Growing utilization of point-of-care cardiac ultrasound by IM physicians may help reveal overlooked markers of worse outcomes in the indexed hospitalization. The ratio of Tricuspid Annular Plane Systolic Excursion (TAPSE)/Echocardiographically measured Pulmonary Artery Systolic Pressure (PASP) may offer insight into right ventricular function and the course of HF decompensation hospitalization in patients with known Pulmonary Hypertension (PH). Methods: We retrospectively reviewed the files of 2500 in-patients adults &gt;18 years old who were admitted to an IM ward in a single tertiary medical center, between 2010-2022. Inclusion criteria included a known prior diagnosis of HF and PH and an in-house echocardiogram performed at the time of admission. TAPSE/PASP coupling was assessed and the quotient was plotted on a logarithmic scale in patients who expired during the indexed hospitalization and those who did not. To assess the length of hospitalization we used a cox regression analysis to compare the probability of discharge based on the degree of TAPSE/PASP coupling. Results: Patients who survived the indexed hospitalization had a median TAPSE/PASP of -3.19 IQR [(-3.505) - (-2.853)] as opposed to -3.47 IQR [(-3.749) - (-3.188)], P &lt;0.000, figure 1. Cox proportional hazard regression model used to assess if there was a difference in hospitalization duration given minimal vs. maximal TAPSE/PASP coupling had a likelihood ratio of 13.25 P = 0.0002, figure 2. Conclusions: Echocardiographically determined TAPSE/PASP is a non-invasive measure of Right Ventricular (RV)-arterial coupling and a good estimator of RV function. In our cohort lower TAPSE/PASP was associated with longer length of hospitalization and mortality.
Abstract 15889: Evaluation of a Novel CTA/DSA-Based Deep-Learning Cerebrovascular Segmentation Method for Cavernous Intracranial Aneurysms
Authors: Aakash Patel, Tatsat Rajendra Patel, Sanyasi Sricharan Veeturi, Muhammad Waqas, Andre Monteiro, Ammad Baig, Adnan H Siddiqui, Vincent M Tutino
Journal: Circulation (2022)

Introduction: CTA is a mainstay diagnostic imaging modality for screening and follow-up of intracranial aneurysms (IAs). One challenge facing neuroradiologists is detection and visualization of IAs on the cavernous internal carotid artery (ICA), which are often obstructed by bony tissue. Such IAs are either missed diagnosed, or must be re-imaged by high-resolution DSA. We sought to evaluate the performance of automated deep learning methods in segmenting cavernous ICA aneurysms from CTA. Methods: In 30 cases, we collected and registered CTA-DSA image pairs to train 2 deep-learning (DL) networks (namely, Brave-Net [BN], and DeepMedic [DM]) for brain vessel segmentation from CTA images of patients with IAs. Segmented DSA was used as the ground truth. Independent testing was performed on a separate cohort of 20 cases to compare network performances. The best-performing network was used for comparison against expert rater assessment in IA detection and segmentation. Quantitative evaluation of expert rater IA segmentation was also performed by comparing IA morphology quantified by parameters, such as size, aspect ratio, neck diameter, and undulation index, against DL predictions. Results: In the independent testing dataset, BN significantly outperformed DM in terms of Dice similarity coefficient DSC (0.875±0.0083 vs. 0.864±0.0075, p=0.004), while DM significantly outperformed BN in terms of precision (0.891±0.016 vs. 0.867±0.017, p&lt;0.001). Qualitative assessment confirmed the superiority of DM in segmenting the IAs located on cavernous ICA. Compared to DM, expert raters missed 7 IAs located on cavernous ICA. Furthermore, DM segmentation provided better measurement of neck diameter (p=0.009), aspect ratio (p=0.029) and shape parameters as compared to the expert rater assessment. Conclusions: A deep learning approach using DM can provide a high-fidelity solution for CTA segmentation of vessels and IAs in the cavernous ICA region.
Abstract 15557: Missed Diagnosis of Constrictive Pericarditis: Importance of Multimodality Imaging
Authors: Soban Ahmad, Melissa Moey, Sivakumar Ardhanari
Journal: Circulation (2022)

Introduction: Constrictive pericarditis is a potentially reversible cause of hypotension that is diagnostically challenging. Multimodality imaging is important in the evaluation of patients for constrictive pericarditis to ensure timely management. Case Presentation: A 68-year-old female with a history of chronic hypotension controlled with midodrine and fludrocortisone, end-stage renal disease, and rheumatoid arthritis was admitted to our hospital following a ground-level fall leading to left femur fracture. At admission, her blood pressure was 100/72 mmHg and heart rate was 84 per minute. No pericardial rub, murmurs, or jugular venous distension were present. Laboratory evaluation revealed normal serum electrolytes, thyroid-stimulating hormone, and morning cortisol levels. A routine transthoracic echocardiogram was performed as part of her perioperative cardiac evaluation that demonstrated a beat-to-beat septal diastolic shudder and annulus reversus suggestive of constrictive pericarditis. These findings were confirmed with cardiac magnetic resonance imaging (CMR) that showed pericardial thickening, tubular-shaped right ventricle with impaired filling, septal bounce as well as respirophasic early diastolic septal flattening. Cardiothoracic surgery was consulted however definitive management with pericardiectomy is pending at the time of this report. Conclusion: With recent advances in tissue Doppler imaging, echocardiography can be used in clinical practice to diagnose constrictive pericarditis. Reversal of the relationship between lateral and medial e` velocities (annulus reversus) and respiration-related ventricular septal shift (septal shudder) are suggestive of constrictive pericarditis.